Better clinical outcome with direct oral anticoagulants in hospitalized heart failure patients with atrial fibrillation
Abstract Background Atrial fibrillation (AF) is common in patients with heart failure and is associated with higher mortality. Although previous studies have reported that direct oral anticoagulants (DOACs) reduce the risk of cardiovascular events in out-patients with AF, it remains unclear whether...
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doaj-adc929df3b204959981d803f7b61e92b2020-11-25T03:59:05ZengBMCBMC Cardiovascular Disorders1471-22612018-01-011811810.1186/s12872-018-0746-zBetter clinical outcome with direct oral anticoagulants in hospitalized heart failure patients with atrial fibrillationAkiomi Yoshihisa0Yu Sato1Takamasa Sato2Satoshi Suzuki3Masayoshi Oikawa4Yasuchika Takeishi5Department of Cardiovascular Medicine, Fukushima Medical UniversityDepartment of Cardiovascular Medicine, Fukushima Medical UniversityDepartment of Cardiovascular Medicine, Fukushima Medical UniversityDepartment of Cardiovascular Medicine, Fukushima Medical UniversityDepartment of Cardiovascular Medicine, Fukushima Medical UniversityDepartment of Cardiovascular Medicine, Fukushima Medical UniversityAbstract Background Atrial fibrillation (AF) is common in patients with heart failure and is associated with higher mortality. Although previous studies have reported that direct oral anticoagulants (DOACs) reduce the risk of cardiovascular events in out-patients with AF, it remains unclear whether DOACs reduce mortality in hospitalized heart failure (HHF) patients with AF. Therefore, we examined the impact of DOACs on mortality in this group of patients. Methods Consecutive 497 HHF patients with AF were retrospectively registered and divided into three groups on the basis of the presence of anticoagulant therapy: non-anticoagulant group (Non, n = 90), Vit K antagonists (VKAs) group (n = 257) and DOACs group (n = 150). We followed up all the patients for mortality. Results In the Kaplan-Meier analysis (mean follow-up of 1093 days), all-cause mortality was significantly lower in the VKAs and DOACs groups than in the Non group (31.1% and 15.3% vs. 43.3%, log-rank P < 0.001). In the multivariable Cox proportional hazard analysis after adjusting for other potential confounding factors, usage of DOACs and VKAs were independently associated with lower mortality in HHF patients AF (DOACs, HR 0.356, P = 0.001; VKAs, HR 0.472, P = 0.002). Furthermore, the propensity-matched 1:1 cohort was assessed based on the propensity score (DOACs, n = 114 and VKAs, n = 114). All-cause mortality was significantly lower in the DOACs group than in the VKAs group in the post-matched cohort (12.3% vs. 35.1%, log-rank P = 0.038). In the Cox proportional hazard analysis, the use of DOACs was associated with lower mortality in the post-matched cohort (HR 0.526, P = 0.041). Conclusion Appropriate use of anticoagulants in HHF patients with AF is important, and DOACs potentially improve all-cause mortality in such patients.http://link.springer.com/article/10.1186/s12872-018-0746-zHeart failureAtrial fibrillationAnticoagulant therapyDirect oral anticoagulantsVitamin K antagonistsMortality |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Akiomi Yoshihisa Yu Sato Takamasa Sato Satoshi Suzuki Masayoshi Oikawa Yasuchika Takeishi |
spellingShingle |
Akiomi Yoshihisa Yu Sato Takamasa Sato Satoshi Suzuki Masayoshi Oikawa Yasuchika Takeishi Better clinical outcome with direct oral anticoagulants in hospitalized heart failure patients with atrial fibrillation BMC Cardiovascular Disorders Heart failure Atrial fibrillation Anticoagulant therapy Direct oral anticoagulants Vitamin K antagonists Mortality |
author_facet |
Akiomi Yoshihisa Yu Sato Takamasa Sato Satoshi Suzuki Masayoshi Oikawa Yasuchika Takeishi |
author_sort |
Akiomi Yoshihisa |
title |
Better clinical outcome with direct oral anticoagulants in hospitalized heart failure patients with atrial fibrillation |
title_short |
Better clinical outcome with direct oral anticoagulants in hospitalized heart failure patients with atrial fibrillation |
title_full |
Better clinical outcome with direct oral anticoagulants in hospitalized heart failure patients with atrial fibrillation |
title_fullStr |
Better clinical outcome with direct oral anticoagulants in hospitalized heart failure patients with atrial fibrillation |
title_full_unstemmed |
Better clinical outcome with direct oral anticoagulants in hospitalized heart failure patients with atrial fibrillation |
title_sort |
better clinical outcome with direct oral anticoagulants in hospitalized heart failure patients with atrial fibrillation |
publisher |
BMC |
series |
BMC Cardiovascular Disorders |
issn |
1471-2261 |
publishDate |
2018-01-01 |
description |
Abstract Background Atrial fibrillation (AF) is common in patients with heart failure and is associated with higher mortality. Although previous studies have reported that direct oral anticoagulants (DOACs) reduce the risk of cardiovascular events in out-patients with AF, it remains unclear whether DOACs reduce mortality in hospitalized heart failure (HHF) patients with AF. Therefore, we examined the impact of DOACs on mortality in this group of patients. Methods Consecutive 497 HHF patients with AF were retrospectively registered and divided into three groups on the basis of the presence of anticoagulant therapy: non-anticoagulant group (Non, n = 90), Vit K antagonists (VKAs) group (n = 257) and DOACs group (n = 150). We followed up all the patients for mortality. Results In the Kaplan-Meier analysis (mean follow-up of 1093 days), all-cause mortality was significantly lower in the VKAs and DOACs groups than in the Non group (31.1% and 15.3% vs. 43.3%, log-rank P < 0.001). In the multivariable Cox proportional hazard analysis after adjusting for other potential confounding factors, usage of DOACs and VKAs were independently associated with lower mortality in HHF patients AF (DOACs, HR 0.356, P = 0.001; VKAs, HR 0.472, P = 0.002). Furthermore, the propensity-matched 1:1 cohort was assessed based on the propensity score (DOACs, n = 114 and VKAs, n = 114). All-cause mortality was significantly lower in the DOACs group than in the VKAs group in the post-matched cohort (12.3% vs. 35.1%, log-rank P = 0.038). In the Cox proportional hazard analysis, the use of DOACs was associated with lower mortality in the post-matched cohort (HR 0.526, P = 0.041). Conclusion Appropriate use of anticoagulants in HHF patients with AF is important, and DOACs potentially improve all-cause mortality in such patients. |
topic |
Heart failure Atrial fibrillation Anticoagulant therapy Direct oral anticoagulants Vitamin K antagonists Mortality |
url |
http://link.springer.com/article/10.1186/s12872-018-0746-z |
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